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1.
Transplant Proc ; 51(6): 1956-1961, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303408

RESUMO

BACKGROUND: New-onset diabetes after transplant is a severe complication that can present in liver transplant recipients, negatively impacting quality of life and graft survival. It also contributes to increased risk of infection, cardiovascular disease, and rejection, which are the main causes of death among liver transplant recipients. The aim of the present study was to assess the risk factors associated with new-onset diabetes after transplant. METHOD: This was a case control study based on the data from 146 liver transplant patients at a reference hospital. The data from the charts were collected using a 2-part form: Part I (sociodemographic variables) and Part II (clinical variables). RESULTS: Multiple analysis showed that pre-existing systemic arterial hypertension (odds ratio [OR], 2.65; 95% CI, 1.12-6.28) and the use of sodium mycophenolate associated with tacrolimus (OR, 2.68; 95% CI, 1.02-7.06) increased the risk of new-onset diabetes after transplant. On comparing the anthropometric variables, lipid panel, and blood glucose levels of liver transplant patients with and without diabetes, higher glycemic levels were found in the group with diabetes (P < .001). CONCLUSION: Pre-existing systemic arterial hypertension and the associated use of sodium mycophenolate and tacrolimus increased the risk of new-onset diabetes after transplant.

2.
Arch Endocrinol Metab ; 63(1): 79-83, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30864635

RESUMO

Thyroid carcinoma (TC) is rare in children, particularly in those aged < 10 years. Several studies have demonstrated a correlation between neoplasms and hyperinsulinemia and insulin resistance, which are often associated with a higher risk for and/or aggressiveness of the neoplasm. Congenital generalized lipodystrophy (CGL) with autosomal recessive inheritance is a rare disease and is characterized by the lack of adipose tissue, severe insulin resistance, and early metabolic disturbances. Here, we reported a rare case of a type 2 CGL in a girl who presented with a papillary TC (PTC) at the age of 7 years. She had no family history of TC or previous exposure to ionizing radiation. She had a generalized lack of subcutaneous fat, including the palmar and plantar regions, muscle hypertrophy, intense acanthosis nigricans, hepatomegaly, hypertriglyceridemia, severe insulin resistance, and hypoleptinemia. A genetic analysis revealed a mutation in the BSCL2 gene (p.Thr109Asnfs* 5). Ultrasound revealed a hypoechoic solid nodule measuring 1.8 × 1.0 × 1.0 cm, and fine needle aspiration biopsy suggested malignancy. Total thyroidectomy was performed, and a histopathological examination confirmed PTC with vascular invasion and parathyroid lymph node metastasis (pT3N1Mx stage). This is the first report to describe a case of differentiated TC in a child with CGL. Severe insulin resistance that is generally observed in patients with CGL early in life, especially in those with type 2 CGL, may be associated with this uncommon presentation of aggressive PTC during childhood.


Assuntos
Lipodistrofia Generalizada Congênita/diagnóstico , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/genética , Neoplasias da Glândula Tireoide/diagnóstico , Criança , Feminino , Humanos , Lipodistrofia Generalizada Congênita/complicações , Lipodistrofia Generalizada Congênita/genética , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/genética
3.
Rev. bras. med. fam. comunidade ; 14(41): e1818, 02/2019. tab, ilus
Artigo em Português | LILACS, Coleciona SUS | ID: biblio-996066

RESUMO

Introdução: A visita domiciliar permite ao profissional de saúde romper com o modelo centrado na doença, voltando-se para uma abordagem centrada no indivíduo. No entanto, observa-se uma grande deficiência na organização e gestão destas, o que muitas vezes dificulta a priorização mais adequada destes pacientes. Objetivo: Apresentar a experiência de uma equipe ao utilizar uma nova ferramenta para avaliação e classificação de risco que visa otimizar a gestão da agenda das visitas domiciliares. Métodos: Trata-se de um relato de experiência de uma equipe de saúde da família, na periferia de uma capital no Nordeste do Brasil, que aplicou esta ferramenta aos pacientes de visita domiciliar entre os meses de junho e novembro de 2017. Resultados: Os dados coletados foram analisados, sendo possível classificar os pacientes quanto ao risco e vulnerabilidade. Esta ferramenta favoreceu o fortalecimento e estruturação do registro, planejamento, avaliação e monitoramento das visitas realizadas nos território. Além disso, deve ser ressaltada sua fácil aplicação e a reprodutibilidade em diferentes cenários da atenção primária. Conclusão: O uso de instrumentos adequados permite identificar pacientes em situação de risco e vulnerabilidade, além de possibilitar a organização da agenda, a identificação das necessidades das pessoas, o acompanhamento das doenças crônicas, propor estratégias, e planejar intervenções futuras.


Introduction: The home visit allows the health professional to break the disease-centered model, turning to an individual-centered approach. However, there is a great deficiency in the organization and management of these, which often makes it more difficult to prioritize these patients. Objective: To present the experience of a team when using a new risk evaluation and classification tool that aims to optimize the management of the home visits schedule. Methods: This is an report of the experience of a family health team, in a peripheric neighborhood of a capital city in the northeast of Brazil, that applied this tool with patients who applied this tool to home visiting patients in the period between June and November 2017. Results: The data collected were analyzed and it was possible to classify the patients regarding risk and vulnerability. This tool favored the strengthening and structuring of the registration, planning, evaluation and monitoring of the visits made in the territory. In addition, its easy application and reproducibility in different primary care settings should be emphasized. Conclusion: The use of appropriate instruments allows the identification of patients at risk and vulnerability, besides organizing the agenda, identifying people's needs, monitoring chronic diseases, proposing strategies, and planning for future interventions


Introducción: La visita domiciliaria permite al profesional de la salud romper con el modelo centrado en la enfermedad, volviéndose hacia un enfoque centrado en el individuo. Sin embargo, se observa una gran deficiencia en la organización y gestión de éstas, lo que a menudo dificulta la priorización más adecuada de estos pacientes. Objetivo: Presentar la experiencia de un equipo en la utilización de una nueva herramienta de evaluación y clasificación de riesgo que visa optimizar la gestión de la agenda de visitas domiciliarias. Métodos: Tratase de un relato de experiencia de un equipo de salud de la familia en la periferia de una capital en el Nordeste de Brasil, donde se aplicó esta herramienta con pacientes asistidos en domicilio entre los meses de junio y noviembre de 2017. Resultados: Los dados obtenidos fueron analizados, siendo posible clasificar según el riesgo y la vulnerabilidad. Esta herramienta favoreció el fortalecimiento y estructuración de registro, planificación, evaluación y monitoreo de las visitas realizadas en el territorio. Además, llamamos la atención a su fácil aplicabilidad y reproductibilidad en diferentes escenarios de la atención primaria a la salud. Conclusión: El uso de instrumentos adecuados permite identificar pacientes en situación de riesgo y vulnerabilidad, además de posibilitar la organización de la agenda, la identificación de las necesidades de las personas, el seguimiento de las enfermedades crónicas, proponer estrategias, y planificar intervenciones futuras


Assuntos
Humanos , Organização e Administração , Atenção Primária à Saúde , Avaliação em Saúde , Serviços de Assistência Domiciliar
4.
Arch. endocrinol. metab. (Online) ; 63(1): 79-83, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-989300

RESUMO

SUMMARY Thyroid carcinoma (TC) is rare in children, particularly in those aged < 10 years. Several studies have demonstrated a correlation between neoplasms and hyperinsulinemia and insulin resistance, which are often associated with a higher risk for and/or aggressiveness of the neoplasm. Congenital generalized lipodystrophy (CGL) with autosomal recessive inheritance is a rare disease and is characterized by the lack of adipose tissue, severe insulin resistance, and early metabolic disturbances. Here, we reported a rare case of a type 2 CGL in a girl who presented with a papillary TC (PTC) at the age of 7 years. She had no family history of TC or previous exposure to ionizing radiation. She had a generalized lack of subcutaneous fat, including the palmar and plantar regions, muscle hypertrophy, intense acanthosis nigricans, hepatomegaly, hypertriglyceridemia, severe insulin resistance, and hypoleptinemia. A genetic analysis revealed a mutation in the BSCL2 gene (p.Thr109Asnfs* 5). Ultrasound revealed a hypoechoic solid nodule measuring 1.8 × 1.0 × 1.0 cm, and fine needle aspiration biopsy suggested malignancy. Total thyroidectomy was performed, and a histopathological examination confirmed PTC with vascular invasion and parathyroid lymph node metastasis (pT3N1Mx stage). This is the first report to describe a case of differentiated TC in a child with CGL. Severe insulin resistance that is generally observed in patients with CGL early in life, especially in those with type 2 CGL, may be associated with this uncommon presentation of aggressive PTC during childhood.

5.
Arch Endocrinol Metab ; 62(5): 566-570, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30462811

RESUMO

Insulin autoimmune syndrome (IAS, Hirata's disease) is a rare hypoglycemic disorder characterized by spontaneous hypoglycemia associated with extremely high circulating insulin levels and positive anti-insulin antibody results. Thus far, most cases have been reported in Asian countries, notably Japan, with few cases reported in western countries. As a possible cause, it is associated with the use of drugs containing sulfhydryl radicals, such as captopril. This report refers to a 63-year-old female Brazilian patient with a history of postprandial hypoglycemia. After extensive investigation and exclusion of other causes, her hyperinsulinemic hypoglycemia was considered to have likely been induced by captopril. Most cases of IAS are self-limiting. However, dietary management, corticosteroids, plasmapheresis, and rituximab have already been used to treat patients with IAS. In our case, after discontinuation of captopril, an initial decrease in insulin autoantibody levels was observed followed by improvement in episodes of hypoglycemia. Although it is a rare disease, IAS should be considered in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia. Patients with suspected IAS must be screened for autoimmunity-related drugs for insulin. Initial clinical suspicion of IAS can avoid unnecessary costs associated with imaging examinations and/or invasive surgical procedures.

6.
Arch. endocrinol. metab. (Online) ; 62(5): 566-570, Oct. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-983788

RESUMO

SUMMARY Insulin autoimmune syndrome (IAS, Hirata's disease) is a rare hypoglycemic disorder characterized by spontaneous hypoglycemia associated with extremely high circulating insulin levels and positive anti-insulin antibody results. Thus far, most cases have been reported in Asian countries, notably Japan, with few cases reported in western countries. As a possible cause, it is associated with the use of drugs containing sulfhydryl radicals, such as captopril. This report refers to a 63-year-old female Brazilian patient with a history of postprandial hypoglycemia. After extensive investigation and exclusion of other causes, her hyperinsulinemic hypoglycemia was considered to have likely been induced by captopril. Most cases of IAS are self-limiting. However, dietary management, corticosteroids, plasmapheresis, and rituximab have already been used to treat patients with IAS. In our case, after discontinuation of captopril, an initial decrease in insulin autoantibody levels was observed followed by improvement in episodes of hypoglycemia. Although it is a rare disease, IAS should be considered in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia. Patients with suspected IAS must be screened for autoimmunity-related drugs for insulin. Initial clinical suspicion of IAS can avoid unnecessary costs associated with imaging examinations and/or invasive surgical procedures.

7.
Cad. Esp. (Ceará) ; 12(1)jan.-jun. 2018.
Artigo em Português | Coleciona SUS | ID: biblio-967190

RESUMO

A partir de 2011, os Ministérios da Saúde e da Educação instituíram programas para prover e fixar os profissionais médicos na atenção primária do Brasil. Este artigo tem como objetivo trazer um relato da implantação destes programas no Ceará a partir de 2012. Trata-se de um estudo descritivo, realizado através de análise documental e coleta de dados que relata a experiência da implantação e implementação dos programas de provimento no estado do Ceará, compreendendo o período entre 2012 e 2016. O Ceará possui, atualmente, 2.352 equipes de saúde da família implantadas, sendo que mais da metade destas são vinculadas aos programas de provimento. Observou-se que 69% dos médicos trabalham nos municípios classificados como G100 e Pobreza. Por meio deste relato de experiência, pode-se considerar a possibilidade de ampliação do número de equipes de saúde da família, capacitando a oportunidade do provimento de médicos para municípios classificados como de extrema pobreza e vulnerabilidade no interior do estado, além de promover a longitudinalidade do cuidado.(AU)


As of 2011, the Ministries of Health and Education have instituted programs to provide and fix medical professionals in primary care in Brazil. This article aims to provide an account of the implementation of these programs in Ceará from 2012. This is a descriptive study, conducted through documentary analysis and data collection that reports on the experience of the implementation of the state's welfare programs of Ceará, comprising the period between 2012 to 2016. Ceará currently has 2,352 family health teams implanted, more than half of which are linked to the provision programs. It was observed that 69% of doctors work in municipalities classified as G100 and Poverty. Through this experience report, it is possible to consider the possibility of expanding the number of family health teams, enabling the provision of doctors to municipalities classified as extreme poverty and vulnerability within the state, in addition to promoting longitudinality of care.(AU)


Assuntos
Atenção Primária à Saúde , Política Pública , Distribuição de Médicos , Equidade em Saúde , Programas Nacionais de Saúde , Brasil
8.
BMC Cardiovasc Disord ; 18(1): 6, 2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-29329523

RESUMO

BACKGROUND: Metabolic abnormalities in congenital generalized lipodystrophy (CGL) are associated with microvascular complications. However, the evaluation of different types of neuropathy in these patients, including the commitment of cardiovascular autonomic modulation, is scarce. The objective of the present study was to determine the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with CGL compared with individuals with type 1 diabetes and healthy subjects. METHODS: Ten patients with CGL, 20 patients with type 1 diabetes and 20 healthy subjects were included in the study. Controls were paired 1:2 for age, gender, BMI and pubertal stage. Heart rate variability (HRV) was analyzed using cardiovascular autonomic reflex tests, including postural hypotension test, Valsalva (VAL), respiratory (E/I) and orthostatic (30/15) coefficients, and spectral analysis of the HRV, determining very low (VLF), low (LF) and high (HF) frequencies components. The diagnosis of CAN was defined as the presence of at least two altered tests. RESULTS: CAN was detected in 40% of the CGL patients, 5% in type 1 diabetes patients and was absent in healthy individuals (p < 0.05). We observed a significant reduction in the E/I, VLF, LF and HF in CGL cases vs. type 1 diabetes and healthy individuals and lower levels of 30/15 and VAL in CGL vs. healthy individuals. A significant positive correlation was observed between leptin and 30/15 coefficient (r = 0.396; p = 0.036) after adjusting for insulin resistance and triglycerides. Autonomic cardiovascular tests were associated with HbA1c, HOMA-IR, triglycerides and albumin/creatinine ratio in CGL cases. CONCLUSIONS: We observed a high prevalence of CAN in young patients with CGL, suggesting that insulin resistance, hypertriglyceridemia and hypoleptinemia, may have been involved in early CAN development. Additional studies are needed to evaluate the role of leptinemia in the physiopathogenesis of the condition.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/inervação , Frequência Cardíaca , Lipodistrofia Generalizada Congênita/fisiopatologia , Adolescente , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/epidemiologia , Biomarcadores/sangue , Glicemia/metabolismo , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Criança , Creatinina/sangue , Estudos Transversais , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/sangue , Resistência à Insulina , Leptina/sangue , Lipodistrofia Generalizada Congênita/diagnóstico , Lipodistrofia Generalizada Congênita/epidemiologia , Masculino , Prevalência , Albumina Sérica Humana/análise , Triglicerídeos/sangue
9.
Rev Rene (Online) ; 18(5): 631-638, set. - out. 2017.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-877289

RESUMO

Objetivo: avaliar a ocorrência da polifarmácia e sua associação com a adesão ao tratatamento farmacológico em pacientes com diabetes mellitus tipo 2. Métodos: estudo transversal realizado com 235 portadores de diabetes mellitus tipo 2 por meio de entrevista sobre os dados sociodemográficos e clínicos, a terapêutica medicamentosa prescrita e a adesão ao tratamento. Para análise dos dados foram utilizados os testes t de Student e quiquadrado, com nível de significância p<0,05. Resultados: a polifarmácia foi evidenciada em 88,4% dos casos com predomínio da moderada. Foram utilizados, em média, 7,5 comprimidos por pessoa dentre os 19 tipos de fármacos prescritos. A adesão à terapêutica prescrita foi relatada por 88,2% dos pacientes avaliados e não houve associação com a polifarmácia (p=0,266). Conclusão: foi verificado que a polifarmácia é uma condição de elevada prevalência e não está associada a pior adesão à terapêutica. (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2 , Adesão à Medicação , Enfermagem , Polimedicação , Terapêutica
10.
Diabetol Metab Syndr ; 6: 67, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24920963

RESUMO

BACKGROUND: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D). METHODS: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups. RESULTS: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001). CONCLUSIONS: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.

11.
Arq Bras Endocrinol Metabol ; 58(4): 369-76, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24936731

RESUMO

OBJECTIVE: To evaluate the effect of sitagliptin on somatosensory-evoked potentials (SEPs) and metabolic control in patients with type 2 diabetes mellitus without clinical diabetic neuropathy. MATERIALS AND METHODS: Interventional, prospective, and open study. Patients with less than six months from the diagnosis were included. Examinations of SEPs and laboratory tests at fasting and after food stimulation were performed before and after three months of treatment with sitagliptin (100 mg/day). RESULTS: There was a reduction in the mean levels of HbA1c (P < 0.0001), fasting glucose (P = 0.001), total cholesterol (P = 0.019), and ALT (P = 0.022). An increase in active GLP-1 was found at the end of the study (P = 0.0025). Several SEPs showed statistically significant differences when analyzed before and after treatment with sitagliptin. CONCLUSION: The results give a glimpse of the possible use of sitagliptin in the treatment of some neurodegenerative conditions of the peripheral nervous system, in addition to its already established role in glycemic control.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Potenciais Somatossensoriais Evocados/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico , Pirazinas/uso terapêutico , Triazóis/uso terapêutico , Ativação Metabólica , Adulto , Alanina Transaminase/sangue , Área Sob a Curva , Aspartato Aminotransferases/sangue , Glicemia/análise , Colesterol/sangue , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Jejum/metabolismo , Feminino , Alimentos Formulados , Peptídeo 1 Semelhante ao Glucagon/sangue , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fosfato de Sitagliptina , Estatísticas não Paramétricas , Triglicerídeos/sangue , gama-Glutamiltransferase/sangue
12.
Arq. bras. endocrinol. metab ; 58(4): 369-376, 06/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-711627

RESUMO

Objective: To evaluate the effect of sitagliptin on somatosensory-evoked potentials (SEPs) and metabolic control in patients with type 2 diabetes mellitus without clinical diabetic neuropathy. Materials and methods: Interventional, prospective, and open study. Patients with less than six months from the diagnosis were included. Examinations of SEPs and laboratory tests at fasting and after food stimulation were performed before and after three months of treatment with sitagliptin (100 mg/day). Results: There was a reduction in the mean levels of HbA1c (P < 0.0001), fasting glucose (P = 0.001), total cholesterol (P = 0.019), and ALT (P = 0.022). An increase in active GLP-1 was found at the end of the study (P = 0.0025). Several SEPs showed statistically significant differences when analyzed before and after treatment with sitagliptin. Conclusion: The results give a glimpse of the possible use of sitagliptin in the treatment of some neurodegenerative conditions of the peripheral nervous system, in addition to its already established role in glycemic control. .


Objetivo: Avaliar o efeito da sitagliptina nos potenciais evocados somatossensoriais (PESS) e controle metabólico de pacientes com diabetes melito tipo 2, sem neuropatia diabética. Materiais e métodos: Estudo de intervenção, prospectivo e aberto. Os pacientes com menos de seis meses de diagnóstico foram incluídos. Exames dos PESS e testes laboratoriais em jejum e após a estimulação com alimentos foram realizados antes e depois de três meses de tratamento com sitagliptina (100 mg/dia). Resultados: Houve redução nos níveis médios de HbA1c (P < 0,0001), glicemia de jejum (P = 0,001), colesterol total (P = 0,019) e ALT (P = 0,022). Verificou-se aumento de GLP-1 ativo (P = 0,0025). Vários PESS mostraram diferenças estatisticamente significativas quando os valores foram analisados antes e após o tratamento com sitagliptina. Conclusão: Os resultados vislumbram a possível utilização de sitagliptina no tratamento de algumas condições neurodegenerativas do sistema nervoso periférico, em adição ao seu papel no controle glicêmico. .


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /tratamento farmacológico , Potenciais Somatossensoriais Evocados/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico , Pirazinas/uso terapêutico , Triazóis/uso terapêutico , Ativação Metabólica , Área Sob a Curva , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Glicemia/análise , Colesterol/sangue , /metabolismo , /fisiopatologia , Alimentos Formulados , Jejum/metabolismo , Peptídeo 1 Semelhante ao Glucagon/sangue , Hemoglobina A Glicada/análise , Estudos Prospectivos , Estatísticas não Paramétricas , Triglicerídeos/sangue , gama-Glutamiltransferase/sangue
13.
Auton Neurosci ; 177(2): 275-9, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23770193

RESUMO

OBJECTIVE: The objective of this study is to investigate the influence of the day-to-day variability of the measures of heart rate variability (HRV) on the sample size calculation for the study of cardiac autonomic neuropathy. MATERIAL AND METHODS: We analyzed HRV in the frequency domain [very low (VLF), low (LF), and high frequency (HF) bands] and in the time domain [the root mean squared of successive RR intervals differences (RMSSD); the mean RR intervals (RRNN); the standard deviation of RR intervals (SDNN) and the coefficient of variation (CV)] during a 5-min electrocardiogram record. We also analyzed the heart rate response to deep breathing [expiration:inspiration ratio], to the Valsalva maneuver and to standing [maximum:minimum ratio] and the blood pressure response to standing. The day-to-day variability was assessed by calculating the within-subject standard deviations (WSSD), limits of agreement, typical errors and the ratio of the WSSD to the mean values obtained on days 1 and 2 (WSSD/GM). RESULTS: Sixty-seven healthy subjects (45 females), aged 27 (19-39) years, were recruited. The RMSSD, CV, VLF, LF, HF and blood pressure response to standing showed marked variability (WSDD/GM (%)=237.7, 455.1, 69.9, 126.5, 81.3 and 380.5, respectively), while the RRNN, SDNN, Valsalva, expiration:inspiration and maximum:minimum ratio showed less variability (WSSD/GM (%)=6.4, 24.5, 18.6, 11.0 and 14.1, respectively). The minimum differences expected to be statistically significant for the autonomic measurements were calculated. CONCLUSION: Some tests that assess HRV showed adequate reproducibility. This study allows the determination of a sample size calculation for longitudinal or drug-testing studies.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Pressão Sanguínea/fisiologia , Eletrocardiografia/normas , Frequência Cardíaca/fisiologia , Postura/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Adulto Jovem
14.
Periodontia ; 23(4): 7-11, 2013. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-853525

RESUMO

O termo hipopituitarismo é usado para designar a deficiência de um ou mais hormônios da hipófise anterior ou posterior. Manifestações dentárias também ocorrem, sendo o atraso na erupção dentária uma característica marcante, porém existem poucos relatos na literatura que investigaram as características periodontais dos pacientes portadores desta alteração, tornado-se assim um dos objetivos do nosso estudo. Foram investigados 19 pacientes portadores de hipopituitarismo, sendo o grupo controle formado por 19 pacientes não portadores de hipopituitarismo, não fumantes, não diabéticos e maiores de 18 anos de idade. Para avaliação periodontal foram realizados exames clínicos completos que incluíram os parâmetros de índice de sangramento gengival (ISG), profundidade de sondagem, recessão e perdas dentárias de cada paciente. Após a aplicação do teste qui-quadrado ao nível de significância de 5% evidenciou-se a ausência de associação significativa entre hipopituitarismo e os parâmetros periodontais avaliados, verificando apenas uma maior prevalência de perdas dentárias nos pacientes portadores de hipopituitarismo em relação ao controle


The term hypopituitarism is used to designate a deficiency of one or more hormones of the anterior or posterior pituitary. Dental manifestations also happens, the delayed tooth eruption a remarkable feature, however there are few reports in the literature showing the characteristics of periodontal patients with this amendment, made it one of the purpose of our study. We investigated 19 patients with hypopituitarism, and the control group of 19 patients without hypopituitarism, non-smoking, non-diabetic and 18 years old. We evaluated the gingival bleeding index (GBI), probing depth, recession and tooth loss for each patient. After application of the chisquare test at a significance level of 5% revealed the absence of any relationship between hypopituitarism with periodontal disease by checking only a higher prevalence of tooth loss in patients with hypopituitarism compared to control


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hipopituitarismo , Doenças Periodontais
15.
Rev. bras. med. fam. comunidade ; 7(24): 139-146, jul./set. 2012. tab, graf
Artigo em Português | LILACS | ID: biblio-879941

RESUMO

As reformas curriculares e a mudança do perfil na formação de profissionais da saúde apresentam muitos desafios. O objetivo deste estudo foi caracterizar as necessidades educacionais em saúde percebidas e representadas pelos profissionais de nível superior que atuam na Estratégia Saúde da Família (ESF) do município de Fortaleza/CE, recém-aprovados em concurso de âmbito municipal. Trata-se de um estudo descritivo com duas etapas. Um estudo transversal em 2006 com aplicação de inquérito para aferição das necessidades de Educação em Saúde, e a segunda etapa em 2011 com a análise documental sobre as ações realizadas para educação permanente dos profissionais da rede municipal de saúde pela Secretaria Municipal de Saúde de Fortaleza. O instrumento utilizado para coleta dos dados foi um questionário semiestruturado, aplicado a profissionais médicos, enfermeiros e odontólogos. Do universo de 900 profissionais recém-concursados, nossa amostra de conveniência contou com 375 respondentes. Observou-se, no estudo, que, quanto ao desejo de realização de pós-graduação, o mestrado profissional, a residência em medicina de família e comunidade, a residência multiprofissional em saúde da família, que são modalidades de pós-graduação que ocorrem em serviço, são necessidades manifestadas por significativa parte dos profissionais. Por outro lado, profissionais também assinalaram a necessidade de cursos de 40 horas de forma pontual. A educação permanente é apontada pela literatura e pelo atual estudo como um caminho para melhoria na qualidade da ESF, por centrar nos processos de trabalho a construção do processo educativo. Para a educação em Saúde gerar efetivos processos de reflexão-ação-reflexão no cotidiano de trabalho, deve-se promover a ligação política com a mudança da formação de perfil profissional e, para isso, colocar em evidência as necessidades educacionais dos profissionais é fundamental.


Curricular reforms and the change in the training profile of health professionals face many challenges. The aim of this study was to characterize the educational needs in health perceived and represented by higher education professionals, who were recently approved in the municipal contest, practicing in the Family Health Strategy (FHS) in Fortaleza, State of Ceara. It is a two-phase descriptive study: a cross-sectional study, with the application of a survey to assess the needs of health education, carried out in 2006; and a documental analysis of the actions taken for the continuing education of professionals from the municipal health system performed by the Municipal Health Secretary of Fortaleza in 2011. Data was collected through a semi-structured questionnaire applied to physicians, nurses and dentists. From the universe of 900 newly gazetted professionals, our convenience sample counted on 375 respondents. Regarding the desire to carry out graduate studies, it was possible to observe that the master's degree training, residency in family and community medicine, and multi-professional residency in family health were significant needs expressed by the professionals in this study. Moreover, practitioners also noted the need to punctual 40-hour courses. Continuing education is cited in the literature and in the current study as a way to improve the quality of the FHS, once it focuses on work processes to build the educational process. To generate effective health education processes of reflection-action-reflection in the daily working, a political connection with the change in the training profile of health professionals must be promoted and, to this end, highlighting the educational needs of professionals is essential.


Las reformas curriculares y el cambio en el perfil de la formación del profesional de la Salud presentan muchos desafíos. El objetivo de este estudio fue caracterizar las necesidades educativas en Salud percibidas y representadas por los profesionales de nivel educativo superior que trabajan en la Estrategia de Salud Familiar (ESF), en Fortaleza / CE, Brasil, recientemente aprobados en concurso público municipal. Este estudio descriptivo tuvo dos fases: la primera fue un estudio transversal en 2006 con la aplicación de una encuesta para evaluar las necesidades de Educación para la Salud; la segunda fue en 2011 con el análisis de los documentos sobre las medidas adoptadas para la educación contínua de los profesionales de la red municipal de salud de la Secretaria Municipal de Salud de Fortaleza. Los datos se recolectaron con un cuestionario semi-estructurado, aplicado a los profesionales médicos, enfermeros y dentistas. Del universo de 900 profesionales recién contratados, nuestra muestra incluyó 375 encuestados. Con relación al deseo de concretar una formación de postgrado: la maestría, la residencia en medicina familiar y comunitaria, y la residencia multiprofesional en salud de la familia (formas de posgrado que pueden cursarse durante el servicio) fueron necesidades manifestadas por una parcela significativa de los profesionales. Por otra parte, los trabajadores también señalaron la necesidad de tener cursos de 40 horas. La educación es citada permanentemente tanto en la literatura como en este estudio como una forma de mejorar la calidad de la ESF, para centrar en los procesos de trabajo la construcción del proceso educativo. Para que la Educación para la Salud genere procesos efectivos de reflexión-acción-reflexión en el trabajo diario, se debe promover la conexión política con el cambio en la formación del perfil profesional y, para ello, es fundamental poner en evidencia las necesidades educativas de los profesionales.


Assuntos
Atenção Primária à Saúde , Educação em Saúde , Estratégia Saúde da Família , Educação Médica Continuada , Necessidades e Demandas de Serviços de Saúde
16.
Arq Bras Endocrinol Metabol ; 56(7): 405-14, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23108744

RESUMO

Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Insulina de Ação Curta/uso terapêutico , Gravidez em Diabéticas/tratamento farmacológico , Glicemia/metabolismo , Feminino , Humanos , Gravidez
17.
Arq. bras. endocrinol. metab ; 56(7): 405-414, Oct. 2012. tab
Artigo em Inglês | LILACS | ID: lil-654268

RESUMO

Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.


A gravidez afeta tanto o metabolismo materno quanto o fetal e, mesmo em mulheres não diabéticas, apresenta um efeito diabetogênico. Entre as mulheres grávidas, 2% a 14% desenvolvem o diabetes gestacional. A gravidez pode ocorrer também em mulheres já diabéticas, o que pode predispor o feto a muitas alterações na organogênese, restrição de crescimento e a mãe a algumas complicações relacionadas ao diabetes, tais como retinopatia e nefropatia, ou acelerar o curso dessas complicações se já estiverem presentes. Pacientes com diabetes gestacional geralmente iniciam seu tratamento com dieta e mudanças no estilo de vida; porém, quando essas medidas falham em atingir um controle glicêmico adequado, a insulinoterapia deve ser considerada. Pacientes com diabetes tipo 2 em uso de hipoglicemiantes orais são aconselhadas a iniciar o uso de insulina. Pacientes com diabetes tipo 1 preexistente devem iniciar um controle glicêmico estrito. Em função do fato de os análogos basais de insulina estarem sendo utilizados muito frequentemente off-label em pacientes grávidas, faz-se necessário avaliar sua segurança e eficácia nessa condição. O objetivo desta revisão é avaliar o uso de tais análogos, tanto de ação curta como prolongada, durante a gravidez, para possibilitar médicos clínicos, obstetras e endocrinologistas escolher o melhor regime terapêutico para suas pacientes.


Assuntos
Feminino , Humanos , Gravidez , Diabetes Mellitus Tipo 1/tratamento farmacológico , /tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Insulina de Ação Curta/uso terapêutico , Gravidez em Diabéticas/tratamento farmacológico , Glicemia/metabolismo
18.
Braz J Otorhinolaryngol ; 78(4): 98-102, 2012 Jul-Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22936144

RESUMO

UNLABELLED: Acromegaly is a rare endocrine disease. Few studies have evaluated its association with hearing loss (HL) and the results are conflicting. AIM: To evaluate the prevalence and features of HL in a group of patients being treated for acromegaly. To analyze peripheral and central auditory transmission. METHODS: Cross-sectional study. A group of 34 patients with acromegaly were submitted to metabolic evaluation, tonal audiometry and brainstem auditory evoked potentials. HL was considered when pure tone average was > 25 DBHL for low frequencies (250, 500, 1000 and 2000 Hz) or high frequencies (3000, 4000, 6000 and 8000 Hz). The patients were divided in group A (with HL) and B (without HL). RESULTS: Twelve patients (35.3%) had sensorineural HL (Group A), being 8 bilateral and 4 unilateral. No one had mixed or conductive HL. The prevalence of diabetes/impaired glucose tolerance was similar between the groups. The frequencies 3000, 4000, 6000 and 8000 Hz were the most affected and with a similar pattern in both ears. CONCLUSION: sensorineural HL was found in 38.9% of cases. Neither clinical nor metabolic differences were noted between the groups, as well as in regards to peripheral and central auditory transmission.


Assuntos
Acromegalia/complicações , Perda Auditiva Neurossensorial/etiologia , Adulto , Audiometria de Tons Puros , Estudos de Coortes , Estudos Transversais , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
19.
Braz. j. otorhinolaryngol. (Impr.) ; 78(4): 98-102, jul.-ago. 2012. graf, tab
Artigo em Português | LILACS | ID: lil-646778

RESUMO

Acromegalia é uma doença endócrina rara. Poucos estudos avaliaram sua associação com deficiência auditiva (DA) e os resultados são conflitantes. OBJETIVOS: Avaliar a prevalência e características da DA em um grupo de pacientes com acromegalia em tratamento. Analisar a transmissão auditiva central e periférica. MATERIAL E MÉTODOS: Estudo transversal. Um grupo de 34 pacientes com acromegalia submeteu-se à avaliação metabólica, audiometria tonal e potenciais evocados auditivos de tronco encefálico (PEATE). Considerou-se DA quando a média dos tons puros foi > 25 DBNA para baixas frequências (250, 500, 1000 e 2000 Hz) ou altas frequências (3000, 4000, 6000 e 8000 Hz). Os pacientes foram divididos em grupo A (com DA) e B (sem DA). RESULTADOS: Doze pacientes (35,3%) mostraram DA sensorioneural (grupo A), sendo oito bilateral e quatro unilateral. Nenhum apresentou DA mista ou condutiva. A prevalência de diabetes/intolerância à glicose de jejum foi similar entre os grupos. As frequências de 3000, 4000, 6000 e 8000 Hz foram as mais afetadas e com padrão similar em ambos os lados. CONCLUSÃO: DA sensorioneural esteve presente em 35,3% dos casos. Não foram notadas diferenças clínicas ou metabólicas significativas entre os grupos, bem como na transmissão neural auditiva periférica e central.


Acromegaly is a rare endocrine disease. Few studies have evaluated its association with hearing loss (HL) and the results are conflicting. AIM: To evaluate the prevalence and features of HL in a group of patients being treated for acromegaly. To analyze peripheral and central auditory transmission. METHODS: Cross-sectional study. A group of 34 patients with acromegaly were submitted to metabolic evaluation, tonal audiometry and brainstem auditory evoked potentials. HL was considered when pure tone average was > 25 DBHL for low frequencies (250, 500, 1000 and 2000 Hz) or high frequencies (3000, 4000, 6000 and 8000 Hz). The patients were divided in group A (with HL) and B (without HL). RESULTS: Twelve patients (35.3%) had sensorineural HL (Group A), being 8 bilateral and 4 unilateral. No one had mixed or conductive HL. The prevalence of diabetes/impaired glucose tolerance was similar between the groups. The frequencies 3000, 4000, 6000 and 8000 Hz were the most affected and with a similar pattern in both ears. CONCLUSION: sensorineural HL was found in 38.9% of cases. Neither clinical nor metabolic differences were noted between the groups, as well as in regards to peripheral and central auditory transmission.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acromegalia/complicações , Perda Auditiva Neurossensorial/etiologia , Audiometria de Tons Puros , Estudos de Coortes , Estudos Transversais , Potenciais Evocados Auditivos do Tronco Encefálico , Perda Auditiva Neurossensorial/diagnóstico
20.
Rev Assoc Med Bras (1992) ; 58(2): 209-14, 2012 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22569616

RESUMO

OBJECTIVE: The objectives of this study are to estimate the prevalence of arterial hypertension (AH) in an adult population with a predominance of families with low education and income levels, in the hinterlands of Pernambuco, Brazil, and to analyze its association with other factors related to cardiovascular diseases (CVD). METHODS: A cross-sectional study in 2008/2009 was conducted with a sample of 198 subjects stratified by age, and representative of the urban adult population of the Canaã district of city of Triunfo, in the hinterlands of Pernambuco, Brazil. RESULTS: One hundred ninety eight individuals with average age of 57.7 years old (31 to 90 years-old), mainly women (65.6%), and with low income and education levels (81.3% with a monthly income of less than one minimum wage) were evaluated. Among these, 127 (64.1%) were identified as having AH, 54 (42.5%) of whom had no prior diagnosis. From those who were previously diagnosed, only 31.3% had good blood pressure control. Higher prevalence was observed in those individuals with lower incomes, higher body mass indexes (BMI), and those with metabolic syndrome (MS). CONCLUSION: These data demonstrated that there was a high prevalence of AH in the urban, low education and income levels adult population of Triunfo, strongly associated with lower income levels, elevated BMI, and the presence of MS; and a high prevalence of bad blood pressure control among the previously diagnosed cases. These results indicate that more effective interventions for early detection and adequate control of this disease and its comorbidities are necessary.


Assuntos
Escolaridade , Hipertensão/epidemiologia , Renda/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Fatores de Risco , População Urbana
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